Doctor Answers 13

Breast Augmentation

August 17th, 2016

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Hi Aimee, I see you have noticed that VS "up-sizes." I kind of think you might have to go a little bigger to get up to your wish of full C or small D. At the same time I believe you have a careful PS who measures. Ask your PS if a high profile could get you a little more volume, like to 400. Here are a few tips for you because this is perhapsthe hardest decision for a patient to make, as well as the surgeon. Also see the video attached to my answer. We spend up to two hours for our BA consultsto be sure there is careful communication. We do a full exam in front of afull-length mirror taking six exact measurements. Weput your photos on a large computer screen for imaging, and go over your“ideal-size” photos. We then save this information to your password protected“web account.” First andforemost the implant should fit the dimensions of your breast and tissue cover. Balancing the implant to yourover-all body shape and tissue cover is essential. The main thing is tohave the diameter of the implant fit the diameter of your breast "foot-print". Higher profile implants tend to have a smaller diameter. Higher is really a marketing term, but oftentranslates into the same volume implant with a narrower base. Saline implants actually tend to decrease indiameter as they are inflated! The average size chosen over our last 7,000 breast implants was“350cc”. BUT, 90% of our patients tell us they wish they werebigger a year after BA. (We will see youevery year for routine checks at no charge.) It’s like your mind incorporatesthe "new you" into your own self-image over a period of time. Cup size estimates can be misleading, but I generally advise patientsthat they will experience an increase of approximately one cup size per 200 cc. You can try on implants in the office byplacing them into a special bra. The implant is also flattened somewhat when underthe muscle, so it is a good idea to bump it up a bit. Approximately 1-ounce (25cc) is added to the final volume to account forflattening of the implant in the partial sub-muscular pocket. Once you decide on a size you like, then addon 25cc, because in real life the implant will be flattened slightly by yourtissues. Multiple measurements need tobe taken to fit an implant to your exact anatomy. Have your surgeon'soffice show you the charts of the implant dimensions for the various profilesof silicone and saline from the manufacturer. Then you and your surgeoncan piece together the puzzle by matching your measurements, with your wishes,versus your tissue cover and the available implants to arrive ata surgical plan. Keep in mindlarger implants tend to have more problems over the years. Since silicone implants wrinkle less thansaline implants, they might be your best bet.
You canalso approximate this at home by measuring out an equivalent amount of riceplaced into a cutoff foot of old panty-hose, and put this in your bra. Wear this around the house for a while, andsee what you think. Implant size mustsquare with assessments of tissue cover, breast diameter, and chest wall width. Multiple measurements of your chest wallare taken (seven in total). Implant sizeselection has been an issue of much discussion.
Therefore, I use a wide variety of methods, but the implant size isalways established preoperatively. Also,patients are advised to bring reference photos demonstrating their ideal sizeand shape. A photo album of patientpictures is maintained to assist them. These photos ultimately help in determiningwhere the implants will be placed, since they can be shifted inside (to providemore cleavage), to the outside, up or superiorly, and down or inferiorly duringsurgery. In determining the final sizeselection, I always place the highest priority on the preoperative measurementsand potential tissue cover. Finally,your verbal requests are factored into the analysis.
We usethe quick-recovery approach, so click on the web reference link below to havethis explained and you can see the list of Quick-Recovery (Flash-Recovery orRapid-Recovery) Breast Augmentation articles from peer-reviewed surgeryjournals. It is a surgical procedure thatuses special instruments and techniques to minimize tissue damage and avoidtouching the ribs. It causes far less trauma to surrounding tissue thantraditional approaches, and it dramatically reduces pain and recovery time. Inpublished studies of BA patients, 95-percent of women interviewed after theprocedure returned to normal daily activities within 24-hours. Quick-recoveryBA is not a “gimmick.” These specializedtechniques, which actually speed recovery and get you back to your dailyroutine, kids and work, are published in our plastic surgery journals. Because these PS journals are “peer-reviewed”and edited, they are the gold-standard in our field as being valid science.Therefore, these are sound techniques, not marketing hype.
Be sureto see only a board certified plastic surgeon (by ABPS - The American Board ofPlastic Surgery) who is a member of ASAPS (The American Society for AestheticPlastic Surgery) and or a member of ASPS (The American Society of PlasticSurgeons). Also, ask if the PS has anestablished, high volume breast augmentation practice, performing severalhundred breast augmentations each year. Be sure the PS has been in practice for awhile, about 20-years might be a good gauge. Does the PS offer all three incisions? Discuss the implant type (gel or saline), shaped "gummy bear"or non-shaped, smooth or textured, implant pocket (over or under the muscle)and the "quick-recovery approach." Ask to see their before and after photos if you didn’t see any on theirwebsite. If they are experienced, they should have several 100 breastimplant patients for you to view. I would also recommend that your doctoroffer you the chance to talk to past patients who would be happy to discusstheir experience with you. You need to feel comfortable, so make sure theenvironment is safe as in an accredited surgery center. Also, ask a prospective surgeon if he or shehas ever published journal articles in professional peer-reviewed journals,which they can provide you. All the best, “Dr. Joe”

Breast Implant Sizing

August 17th, 2016

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Hello,You are the first person ever to mention another measurement besides breast width! Congratulations. Keep in mind that this should be done by a surgeon who is very experienced in doing this, so that consistent and accurate measurements can be determined for implant sizing. Unfortunately, a 350 cc implant needs about 8.5 cm from nipple to inframammary fold, which would require too much of a fold lowering, putting you at risk of a double bubble. Based on your measurements, I would not go further than around 275 cc. As for bra sizes, regardless of your previously mention issues of anatomic capacity, women should not conceptualize breast size using bra cup sizes. It is better to just get sized in your surgeons office and look at yourself in the mirror, which is really the most important thing - how you look.Best

How to determine the best implant size for breast augmentation.

August 16th, 2016

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The best way to determine the best breast implant size for breast augmentation is to try on sizers in your doctor's office to make sure that you like the appearance you see in the mirror. Ultimately I always have the patient choose the actual size of the implant because you know what you really want, BUT the implant has to fit within the base width measurements that I determined during the exam.With that explanation I can only say that you need to be the judge.I would respectfully disagree with your surgeon on your measurements however. I measure my patients differently because the general trend across the country is to create breasts that are very busty, buxom and wide; a lot of women seem to have breasts just as wide as their shoulders after breast augmentation and I (and my patients) do not like that look. Using wide implants for breast augmentation seems to make patients look heavier than they really are as well. Based on your photo and height/weight I bet I would measure you at a base width of 9.5 or 10. What difference would that make for you? It means that I would suggest an implant that is much narrower and would not tend to wrap around toward your armpit and give you "side boob". Please know that I am just about alone in my views regarding breast augmentation and most if not all other plastic surgeons would agree with your current measurements. But your appearance seems to fit right in with about 85% of my patients. If you want more information about my perspective or opinions about breast augmentation you can download a free breast augmentation planner at aBetterBreast.comGood luck with your decision. I wish you the best.

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Moderate Plus versus High Profile?

August 19th, 2016

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Aimee, Yes, I believe this implant choice will get you to a Victoria Secret C or D and maybe a regular C as well. Depending on your opinion of "side boob", you might want to consider asking your surgeon about the high profile 350cc implant. The base diameter of the high profile is narrower than the moderate plus diameter, and the high profile has more forward projection. All the best.

Implnat size

August 17th, 2016

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: implant size The best way to pick implant size is based on your breast and chest width and not the volume. As the implants get bigger, they get wider. When the width of the implant fits the width of your chest, it will look nice and fit your frame. If the implants are too small, you will have a gap between them and they may look too far apart. If they are too wide, they will make you look top heavy as they may be too wide and stick well out past the sides of your chest. There are ways to get a bigger or smaller look.This can be done by picking a different implant profile. The higher the profile, the narrower the base width of the implant. If someone has a very narrow chest and wants to be big, they should consider a higher profile implant. If someone has a broad chest and they do not want to be too big but want to avoid the gap and still have cleavage without projection, they should consider a lower profile implant such as a moderate. There are options in between these such as the moderate plus. I prefer the underarm approach so there is no scar on your breast. The new silicone is the only way to go as far a rippling as the new silicone ripples much less than saline, especially in the larger implants.

Thank you for your question. Before you make your final decision on size and shape of implants I would suggest that you meet again with your Board Certified Plastic Surgeon again and go over your concerns and why you feel a specific implant would give you the results you desire. Your surgeon should be able to explain to you why they are recommending the size they are according to your current breast measurements including your chest width and your desired outcome. Your Surgeon should be able to advise you thoroughly on your options.
We have all our Breast Augmentation patients not only utilize our 3D imaging so they can get a real visual on what the implants will look like on them but also to actually try on the different size implants with a tight bra and t-shirt to see what they might expect. That way they have a good visual of what a 450cc implant will do as opposed to a 350cc implant for example. You want to make sure that you see a surgeon that will listen to you and your goals for the procedure and discuss in detail their recommendation for size and shape not only taking into consideration your desired outcome but also your breast measurements before the procedure including your chest dimensions. And then let you try the implants that they feel will give you the desired result so you are in agreement with the size.

Breast augmentation

August 17th, 2016

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Hello and thank you for your question. The size of the implant is based on your desired
breast size/shape, your chest wall measurements, and soft tissue
quality. This decision should be based on a detailed discussion
with equal input from both you and your surgeon. Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their results. The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.

The right size for you

August 16th, 2016

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It is very difficult to determine the best lift you will need (recommended based on your photos) or the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. The same process goes for just filling in the upper part of your breast without becoming much larger. Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below including silicone vs saline implants

Will 350cc be a good choice for me?

August 16th, 2016

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Thank you for the question. Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery. Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.

***Given that your surgery is coming up soon, I would suggest that you spend additional time communicating your goals/concerns directly with your plastic surgeon, preferably prior to the date of surgery.

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.

2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “natural” or "full C or small D cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.

3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

These answers are for educational purposes and should not be relied upon as
a substitute for medical advice you may receive from your physician. If you
have a medical emergency, please call 911. These answers do not constitute
or initiate a patient/doctor relationship.